low ACHT, normal cortisone

[rencat13]

I've suffered chronic tiredness for at least 10 years (I'm 36 years old). I've seen numerous Dr's over the years and I'm now at my wits ends and I want a real diagnosis. I've had a sleep study done and was diagnosed with hypersomnolence (excessive day time sleepiness). I was subsequently prescribed dexamphetamine, which has been a life saver, however I don't want to take these for the rest of my life. Given my symptoms, I thought I may have adrenal fatigue, however my results from a cortisol/ACHT test came back as:

Cortisol (spot level) - 394 nmol/l (normal range 140 - 600)
ACHT (plasma) 2.1 pmol/L (normal range 2.0 - 10.0)

I know they are both considered normal, however I'm at the lower end for ACHT. Could this possibly be contributing to my fatigue? My other symptoms include weight loss, sore/tired eyes, low bp, NO sex drive. Even on the dexamphetamine I can still fall asleep. In particular, my tiredness is overwhelming around 3-5 pm.

Also, is this a normal reading - I didn't think you could have a low ACHT and normal cortisone as one hormone affects the other.

[rumpled]

Hopefully the endo will do a full check.  The GP did some basics but alas not enough and not what I would call full coverage as in he left off testosterones and thyroid antibodies to start.  
If the doc did any basic panels usually sodium and potassium are in those.  Hope you can see the endo soon there are a lot of waits even to seen mine as an established patient I have a long wait.

[rencat13]

At the moment, I don't have any nausea. I went to the GP today and requested bloods for TSH, T4, T3, LH, FSH, DHEA, iodine and iron. Damn, I forgot about the Na....and prolactin. However, I'm breastfeeding and my milk supply is fine. My GP also referred me to an endocrinologist. Hopefully I'm a step closer to having a diagnosis.

[rumpled]

How is the sodium now? What about  the nausea?

Libido can be cortisol or so many other hormones.  Has prolactin been checked?

[rencat13]

Thanks again for your reply. I will definitely look into getting more tests done along with the stimulation test. I had below normal sodium levels when I was pregnant, but I attributed that to my hyperemesis (severe morning sickness) as I was unable to eat or drink and feed via a NG tube for 3 months. I've always had low bp. Prior to my last pregnancy, I would have sworn I was pregnant as I always felt nauseous, yet I knew it was impossible as I hadn't had sex for months (sorry if too much info!)....but as I previously mentioned, I have no sex drive, which I believe is also due to hormones.
Anyway, I guess there's no point in me trying to diagnose myself. Hopefully after a few more tests I will have the answer - fingers crossed.

[rumpled]

Yippee for the lab tech!  There are some meds that I know impact testing to maker higher or lower and you can search for lists.

Is that your only set of tests? One test does not make for diagnosis and as we'll, usually for AI one has low sodium.

Do you have low blood pressure?  Salt cravings? Nausea?

[rencat13]

Thanks for your reply. I know the technician immediately put the tube in the centrifuge and then left the room, as she said she needed to put the blood sample in the freezer, so I presume the test was done correctly. I'm wondering if my stimulant medication could be the reason why my cortisol levels are normal and if in fact, they would be lower without the medication, then indicating adrenal insufficiency? I'm going to get my other hormones tested next week, so hopefully will have a better idea.

[rumpled]

The lower level of ACTH can be explained most times by poor lab handling as unless it was a chilled tube, put right in the centrifuge from the draw and the tech told you they would freeze it right away, the ACTH degrades in the bin and the results show up lower.

It could be other hormones, or other vitamins at fault?